How Practices Can Ensure All Patients Have Access to Dental Care While Reducing Reliance on Medicaid
Medicaid, a joint federal and state program, provides health and long-term care coverage for more than 81 million Americans, including children, older adults, low-income individuals, and people with disabilities. While its purpose is critical, the system's limitations have created significant challenges for patients and providers, especially in dental care.
For many dental practices, participating in Medicaid might seem like the only way to serve underserved populations. But with unpredictable coverage, low reimbursement rates, and operational burdens, it's clear the current model isn't sustainable. Fortunately, there's a better way to deliver care to those who need it most: dental membership plans.
Medicaid's instability makes it hard to deliver consistent care
Medicaid dental coverage varies significantly from state to state. Some states offer robust dental benefits, while others provide only emergency care or none at all. This inconsistency leaves many providers navigating a fragmented system that impacts how they treat patients and run their practices.
Making matters worse, Medicaid is currently in flux. As of September 2024, more than 25 million Americans have been disenrolled due to the expiration of continuous enrollment protections. Millions are now without dental coverage, forcing providers to rethink their participation and consider whether Medicaid is the most effective way to reach underserved patients.
Membership plans offer a clear alternative
When patients lose Medicaid dental coverage or never had it in the first place, they often avoid seeking care altogether due to cost concerns. However, practices don’t have to choose between profitability and patient access.
Dental membership plans offer an innovative solution that balances patient affordability with practice sustainability. These plans give patients direct access to care at transparent, discounted rates—without the red tape of insurance. At the same time, practices gain a predictable revenue stream and reduce the administrative strain associated with Medicaid claims and reimbursements.
The hidden costs of Medicaid vs. the ROI of membership
Nationally, the average Medicaid reimbursement for dental services sits at just 29.9%. That means practices often operate at a loss, particularly in states with limited benefits. Shifting to a cash pay model might seem like an easy way out, but it often leads to inconsistent revenue and patients deferring necessary care.
Membership plans fill the gap. Patients who enroll in a membership plan commit to your practice, visit more frequently, and are more likely to accept treatment. This results in better oral health outcomes and higher practice revenue.
Flexible plan design for Medicaid-eligible populations
One of the biggest strengths of membership plans is their adaptability. You can design your plan to reflect the unique needs of your patient base:
- Low-cost entry plans for basic care (e.g., cleanings, exams, and x-rays) can attract patients recently disenrolled from Medicaid.
- Preventive-focused plans that include hygiene and diagnostics help catch issues early and increase case acceptance.
- Tiered options let patients choose the level of care that fits their budget while giving practices full control over pricing and benefits. This level of flexibility isn’t possible with Medicaid, but it is with Kleer and Membersy.
Before you build your own plan, ask the right questions
If you're considering a DIY in-house plan, consider these questions first: Can your team build, price, and manage a compliant plan? Do you have the tools to automate renewals and payments? Can your staff manage member questions, reporting, and marketing? Are you prepared to meet DMPO licensure and compliance requirements? If the answer is "no" to any of these, a trusted partner might be the better route.
Membership plans empower your practice and your patients
In an era where Medicaid is becoming more uncertain and reimbursement rates continue to fall, practices need a sustainable model that supports both patient care and business growth. Dental membership plans provide a clear, proven path forward.
Whether you're looking to reduce reliance on Medicaid or find new ways to support patients who have lost coverage, a Kleer and Membersy-powered membership plan can help you deliver care with confidence.
Talk to a plan expert today and learn how to bring accessible, affordable dental care to your community—on your terms.
This blog has been updated since its original publication on October 15, 2024.
About the author
Lynnea is a Demand Generation Analyst at Kleer and Membersy, specializing in the B2B SaaS industry. With a prior background in content marketing, Lynnea works to create strategic content for dental teams designed to improve business outcomes.
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